Rapidly progressive stridor in a case of GIST

We report the case of an 84-year-old male patient suffering from a gastrointestinal stromal tumour (GIST) of the rectum who was referred to our ENT (Ear-Nose-Throat) clinic for a rapidly progressive stridor, aphagia and dysphonia. The clinical examination revealed a mass arising from the posterior wall of the pharynx, which obstructed the laryngeal inlet and thus the airway. A metastasis of the GIST was suspected. After completing the investigation with radiological imaging, the patient underwent surgery, which consisted of a tracheostomy to secure the airway and a biopsy of the mass. The pathological examination confirmed the suspected diagnosis of a GIST vertebral metastasis.

Synchronous Gastrointestinal Stromal Tumor (GIST) of the Rectum And Jejunum: A Rare Case Report

Introduction: GIST are rare tumor and uncommon to occur in rectum where it accounts about 5% of all GIST [1] and rarer to develop simultaneously. Several surgical options are available, large tumours with aggressive features have been commonly treated with abdominoperineal resection.This is the first reported case of synchronous GIST of the rectum and jejunum. Case report: 66 year old man who presented with rectal bleeding and altered bowel habit. Colonoscopy revealed submucosal tumor on anterior wall of the rectum. Computerized Tomography (CT) of abdomen and Magnetic Resonance Imaging (MRI) of pelvis demonstrated a mass of approximately 88 AP x 88 W x 89mm CC in size on the anterior wall of the rectum at a distance of 2.3 cm from the anal verge, without any invasion to the prostate or evidence of metastasis, Histological examination of the biopsy sample via the rectum showed spindle cell neoplasm suggestive of GIST. An abdominoperineal resection was performed with wedge resection of small bowel lesion who discovered intraoperatively as yellow mass measuring 1.5 cm in its diameter involving the serosa. Histopathological examination of the sample confirmed the diagnosis of GIST of both rectal and small bowel specimen with positive CD117 on immunohistochemical assessment. Patient recovered post operatively. Discussion: Incidence of GIST as overall are about 1/100000 per year and commonly found in stomach (60-70%), small intestine (20-25%) but rarely occur in rectum (5%). Because of the low incidence of rectal GISTs, cases of simultaneous development of a GIST in rectum and jejunum are scarce. Simple coincidence could be the reasonable explanation in our case. For rectal GIST, surgical procedures may be considered, including abdomino-perineal resection. Conclusion: Simultaneous GISTs in the rectum and jejunum is extremely rare. Resection is the treatment of choice, suspicious lesions discovered during operation should be biopsied or removed as GIST could appear synchronously.

Case of leptosuccin induced malignant hyperthermia in a patient with GIST of the rectum

Malignant hyperthermia (MH) is a form of myopathy that is usually triggered by volatile anaesthetics such as halothane, sevoflurane and des flurane and depolarising muscle relaxants such as succinylcholine. Pathologic response in MH inc1ude increase in oxygen consumption, increase in endtidal C02, tachycardia, hyperthermia, hyperkalemia and muscle rigidity. Immediate recognition and treatment are crucial to avoid lethal outcome. Molecular genetic studies have confirmed that ryanodine muscle receptors are responsible for MH. We present a case of leptosuccin induced MH with masseter muscle rigidity, mild pC02 increase (6.3 kPa), elevated body temperature measured with esophageal temperature probe (39.5?C) tachycardia (115 beats/min) and respiratory and metabolic acidosis (pH was 7,23) in a patient who underwent low anterior resection of the rectum for gast rointestinal stromal tumor (GIST) of the rectum.